Scleral lenses are large-diameter rigid lenses that vault over the cornea and rest on the sclera, the white of the eye. That design allows for clearer vision, with far less of the distortion and ghosting that comes with an irregular cornea.

These lenses can dramatically improve vision quality for the right patients, giving clearer sight than traditional methods can. At Envision Eye Center, scleral lenses are one of the most rewarding treatments we offer, because of how much they can change a patient's day-to-day life.

What are scleral lenses, exactly?

When the cornea is irregular, light entering the eye is refracted in multiple directions, creating distortion and ghosting. Traditional soft lenses drape over the cornea and take on that same irregular shape, so vision stays blurred. Rigid gas permeable (RGP) lenses are small and firm, and while they help some people, they often shift too much, leading to discomfort and fluctuating vision.

Scleral lenses vault completely over the cornea and rest on the white of the eye. The large diameter keeps the lens stable, and because it only lands on the sclera, it's far more comfortable than a traditional RGP. A layer of sterile saline fills the space between the lens and the cornea, forming a smooth optical surface that delivers clear vision even when the cornea itself is irregularly shaped. It's that smooth refracting surface that can correct corneas no other lens or pair of glasses can fully correct.

Who needs scleral lenses?

Scleral lenses help a range of corneal and ocular-surface conditions:

• Keratoconus, the most common reason for a scleral lens. This progressive corneal disease thins the cornea and creates an irregular cone shape.
• Pellucid marginal degeneration, another progressive disease that creates an irregular shape in the periphery of the cornea.
• Post-LASIK ectasia & post-refractive complications, where LASIK, PRK or RK have left an irregular corneal surface and distorted vision.
• Corneal transplants (post-keratoplasty), where sutures and the junction between donor and host cornea create an irregular surface.
• Severe dry eye & ocular surface disease, where the lens's saline reservoir continuously bathes the cornea, making it a therapeutic device as well as a visual one.
• High astigmatism or high prescriptions, where the optics of glasses cause distortion (though insurance may not deem these medically necessary).
• Corneal scarring from injuries or severe infections that leave an irregular surface.

What to expect during a scleral lens fitting

Visit 1 — Comprehensive eye exam

Your first visit is a comprehensive eye exam, so we know your prescription and the overall health of your eyes. We also evaluate the shape of your cornea and take a topography, a 3-D map of the cornea. Think of this as the data-gathering visit that guides the fitting.

Visit 2 — Diagnostic fitting

After reviewing your information, we choose appropriate trial lenses and place them on your eyes, then evaluate how they fit both over the cornea and where they land on the sclera. Once the fit looks right (which may take a few trial lenses), we let them settle for 20–30 minutes, reassess, and fine-tune the prescription. Because of that settling period, this visit can last up to an hour. We then send your custom parameters to the lab, which usually takes two to three weeks to make your lenses.

Visit 3 — Dispensing & training

Your custom lenses arrive, and a technician teaches you to insert and remove them using a small insertor and saline. Nobody gets this on the first try, so be patient with yourself. It tends to feel awkward for the first few days, and most patients are comfortable inserting within a week.

Follow-up visits

After about a week of wear, we check the fit and vision and adjust parameters if needed. If changes are necessary, we order new lenses and schedule additional follow-ups until everything fits comfortably.

Cost, insurance & practical considerations

Scleral lenses are medically necessary for keratoconus and many other conditions, which means most major vision plans cover a significant portion.

• Fitting fees are usually billed separately from the lenses, and most plans cover them (insertion-and-removal training is typically the exception).
• Lenses typically last about one year before replacement.
• You'll need an annual eye exam and lens fitting each year for new lenses, but these usually involve far fewer follow-ups than the initial fitting.

We want you to see better. Our office will work with your insurance to find out whether scleral lenses are covered under your medically necessary benefits.

Living with scleral lenses

Scleral lenses do call for a few extra accessories for insertion and removal, plus a specialized preservative-free saline in addition to your regular contact-lens solution. They're a bit more involved than other lenses, but most patients find the benefits far outweigh the extra steps.

You'd care for them like any other contact lens: never sleep in them, and keep water away, which means taking them out before swimming or showering.

Frequently asked questions